|
HC PERCU INJ-ABLATIVE AGENT LIVER
|
Facility
|
IP
|
$2,026.00
|
|
|
Service Code
|
CPT 47399
|
| Hospital Charge Code |
909081849
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$405.20 |
| Max. Negotiated Rate |
$1,823.40 |
| Rate for Payer: Adventist Health Commercial |
$405.20
|
| Rate for Payer: Cash Price |
$911.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,620.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,418.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.40
|
| Rate for Payer: EPIC Health Plan Senior |
$810.40
|
| Rate for Payer: Galaxy Health WC |
$1,722.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,823.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,286.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,195.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.20
|
| Rate for Payer: Multiplan Commercial |
$1,519.50
|
| Rate for Payer: Networks By Design Commercial |
$1,316.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,722.10
|
|
|
HC PERCU INJ-ABLATIVE AGENT LIVER
|
Facility
|
OP
|
$2,026.00
|
|
|
Service Code
|
CPT 47399
|
| Hospital Charge Code |
909081849
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$405.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$405.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$910.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$980.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,178.52
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$911.70
|
| Rate for Payer: Cash Price |
$911.70
|
| Rate for Payer: Cash Price |
$911.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,620.80
|
| Rate for Payer: Cigna of CA HMO |
$1,296.64
|
| Rate for Payer: Cigna of CA PPO |
$1,499.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,418.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$1,722.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,823.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,286.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,519.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,316.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$910.78
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$1,722.10
|
| Rate for Payer: Prime Health Services Medicare |
$965.43
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$1,001.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,215.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,013.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC PERCU RFA BONE INCLUDES CT GUI
|
Facility
|
OP
|
$17,628.00
|
|
|
Service Code
|
CPT 20982
|
| Hospital Charge Code |
909081838
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,525.60 |
| Max. Negotiated Rate |
$37,209.84 |
| Rate for Payer: Adventist Health Commercial |
$3,525.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$22,551.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,806.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,551.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$26,048.55
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$7,932.60
|
| Rate for Payer: Cash Price |
$7,932.60
|
| Rate for Payer: Cash Price |
$7,932.60
|
| Rate for Payer: Central Health Plan Commercial |
$14,102.40
|
| Rate for Payer: Cigna of CA HMO |
$11,281.92
|
| Rate for Payer: Cigna of CA PPO |
$13,044.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,806.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,551.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,339.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,209.84
|
| Rate for Payer: EPIC Health Plan Senior |
$24,806.56
|
| Rate for Payer: Galaxy Health WC |
$14,983.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,576.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,865.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36,984.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,326.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,551.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,193.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,988.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31,571.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,525.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30,218.90
|
| Rate for Payer: Multiplan Commercial |
$13,221.00
|
| Rate for Payer: Multiplan WC |
$26,048.55
|
| Rate for Payer: Networks By Design Commercial |
$11,458.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22,551.42
|
| Rate for Payer: Preferred Health Network WC |
$26,580.15
|
| Rate for Payer: Prime Health Services Commercial |
$14,983.80
|
| Rate for Payer: Prime Health Services Medicare |
$23,904.51
|
| Rate for Payer: Prime Health Services WC |
$25,782.75
|
| Rate for Payer: Riverside University Health System MISP |
$24,806.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,576.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,814.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,551.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,806.56
|
| Rate for Payer: Vantage Medical Group Senior |
$22,551.42
|
|
|
HC PERCU RFA BONE INCLUDES CT GUI
|
Facility
|
IP
|
$17,628.00
|
|
|
Service Code
|
CPT 20982
|
| Hospital Charge Code |
909081838
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,525.60 |
| Max. Negotiated Rate |
$15,865.20 |
| Rate for Payer: Adventist Health Commercial |
$3,525.60
|
| Rate for Payer: Cash Price |
$7,932.60
|
| Rate for Payer: Central Health Plan Commercial |
$14,102.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,339.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,051.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,051.20
|
| Rate for Payer: Galaxy Health WC |
$14,983.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,576.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,865.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,193.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,400.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,525.60
|
| Rate for Payer: Multiplan Commercial |
$13,221.00
|
| Rate for Payer: Networks By Design Commercial |
$11,458.20
|
| Rate for Payer: Prime Health Services Commercial |
$14,983.80
|
|
|
HC PERCU-STAY
|
Facility
|
IP
|
$19.00
|
|
| Hospital Charge Code |
909001085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Central Health Plan Commercial |
$15.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7.60
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Multiplan Commercial |
$14.25
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
|
|
HC PERCU-STAY
|
Facility
|
OP
|
$19.00
|
|
| Hospital Charge Code |
909001085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.05
|
| Rate for Payer: Blue Shield of California Commercial |
$12.05
|
| Rate for Payer: Blue Shield of California EPN |
$7.58
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Central Health Plan Commercial |
$15.20
|
| Rate for Payer: Cigna of CA HMO |
$12.16
|
| Rate for Payer: Cigna of CA PPO |
$14.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7.60
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.30
|
| Rate for Payer: Multiplan Commercial |
$14.25
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
| Rate for Payer: Riverside University Health System MISP |
$7.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9.50
|
| Rate for Payer: United Healthcare HMO Rider |
$9.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.15
|
| Rate for Payer: Vantage Medical Group Senior |
$16.15
|
|
|
HC PERCUTANE DISTAL PHAL FRAC EA
|
Facility
|
OP
|
$22,736.00
|
|
|
Service Code
|
CPT 26756
|
| Hospital Charge Code |
900501333
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$20,462.40 |
| Rate for Payer: Adventist Health Commercial |
$4,547.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$10,231.20
|
| Rate for Payer: Cash Price |
$10,231.20
|
| Rate for Payer: Cash Price |
$10,231.20
|
| Rate for Payer: Cash Price |
$10,231.20
|
| Rate for Payer: Central Health Plan Commercial |
$18,188.80
|
| Rate for Payer: Cigna of CA HMO |
$14,551.04
|
| Rate for Payer: Cigna of CA PPO |
$16,824.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,915.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$19,325.60
|
| Rate for Payer: Global Benefits Group Commercial |
$13,641.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,462.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,437.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$693.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,547.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$17,052.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$14,778.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$19,325.60
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,641.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,368.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11,368.00
|
| Rate for Payer: United Healthcare HMO Rider |
$11,368.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,368.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC PERCUTANE DISTAL PHAL FRAC EA
|
Facility
|
IP
|
$22,736.00
|
|
|
Service Code
|
CPT 26756
|
| Hospital Charge Code |
900501333
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,547.20 |
| Max. Negotiated Rate |
$20,462.40 |
| Rate for Payer: Adventist Health Commercial |
$4,547.20
|
| Rate for Payer: Cash Price |
$10,231.20
|
| Rate for Payer: Central Health Plan Commercial |
$18,188.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,915.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,094.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,094.40
|
| Rate for Payer: Galaxy Health WC |
$19,325.60
|
| Rate for Payer: Global Benefits Group Commercial |
$13,641.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,462.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,437.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,414.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,547.20
|
| Rate for Payer: Multiplan Commercial |
$17,052.00
|
| Rate for Payer: Networks By Design Commercial |
$14,778.40
|
| Rate for Payer: Prime Health Services Commercial |
$19,325.60
|
|
|
HC PERCUTANEOUS SHEATH INTRO 7FR
|
Facility
|
IP
|
$237.30
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901608009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.46 |
| Max. Negotiated Rate |
$213.57 |
| Rate for Payer: Adventist Health Commercial |
$47.46
|
| Rate for Payer: Cash Price |
$106.79
|
| Rate for Payer: Central Health Plan Commercial |
$189.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$166.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.92
|
| Rate for Payer: EPIC Health Plan Senior |
$94.92
|
| Rate for Payer: Galaxy Health WC |
$201.71
|
| Rate for Payer: Global Benefits Group Commercial |
$142.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$213.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$150.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.46
|
| Rate for Payer: Multiplan Commercial |
$177.97
|
| Rate for Payer: Networks By Design Commercial |
$154.25
|
| Rate for Payer: Prime Health Services Commercial |
$201.71
|
|
|
HC PERCUTANEOUS SHEATH INTRO 7FR
|
Facility
|
OP
|
$237.30
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901608009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.46 |
| Max. Negotiated Rate |
$235.49 |
| Rate for Payer: Adventist Health Commercial |
$47.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$130.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$114.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.04
|
| Rate for Payer: Blue Shield of California Commercial |
$150.45
|
| Rate for Payer: Blue Shield of California EPN |
$94.68
|
| Rate for Payer: Cash Price |
$106.79
|
| Rate for Payer: Cash Price |
$106.79
|
| Rate for Payer: Central Health Plan Commercial |
$189.84
|
| Rate for Payer: Cigna of CA HMO |
$151.87
|
| Rate for Payer: Cigna of CA PPO |
$175.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$201.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$201.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$166.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.92
|
| Rate for Payer: EPIC Health Plan Senior |
$94.92
|
| Rate for Payer: Galaxy Health WC |
$201.71
|
| Rate for Payer: Global Benefits Group Commercial |
$142.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$213.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$150.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$166.11
|
| Rate for Payer: Multiplan Commercial |
$177.97
|
| Rate for Payer: Networks By Design Commercial |
$154.25
|
| Rate for Payer: Prime Health Services Commercial |
$201.71
|
| Rate for Payer: Riverside University Health System MISP |
$94.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$118.65
|
| Rate for Payer: United Healthcare All Other HMO |
$118.65
|
| Rate for Payer: United Healthcare HMO Rider |
$118.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$118.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$201.71
|
| Rate for Payer: Vantage Medical Group Senior |
$201.71
|
|
|
HC PERCUTANEOUS SKELETAL FIXATION
|
Facility
|
IP
|
$12,212.00
|
|
|
Service Code
|
CPT 24538
|
| Hospital Charge Code |
900501694
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,442.40 |
| Max. Negotiated Rate |
$10,990.80 |
| Rate for Payer: Adventist Health Commercial |
$2,442.40
|
| Rate for Payer: Cash Price |
$5,495.40
|
| Rate for Payer: Central Health Plan Commercial |
$9,769.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,548.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,884.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,884.80
|
| Rate for Payer: Galaxy Health WC |
$10,380.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,327.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,990.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,754.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,205.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,442.40
|
| Rate for Payer: Multiplan Commercial |
$9,159.00
|
| Rate for Payer: Networks By Design Commercial |
$7,937.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,380.20
|
|
|
HC PERCUTANEOUS SKELETAL FIXATION
|
Facility
|
OP
|
$12,212.00
|
|
|
Service Code
|
CPT 24538
|
| Hospital Charge Code |
900501694
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$15,398.95 |
| Rate for Payer: Adventist Health Commercial |
$2,442.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Cash Price |
$5,495.40
|
| Rate for Payer: Cash Price |
$5,495.40
|
| Rate for Payer: Cash Price |
$5,495.40
|
| Rate for Payer: Cash Price |
$5,495.40
|
| Rate for Payer: Central Health Plan Commercial |
$9,769.60
|
| Rate for Payer: Cigna of CA HMO |
$7,815.68
|
| Rate for Payer: Cigna of CA PPO |
$9,036.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,548.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Galaxy Health WC |
$10,380.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,327.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,990.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,754.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$801.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,032.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,442.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$9,159.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$7,937.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Commercial |
$10,380.20
|
| Rate for Payer: Prime Health Services Medicare |
$9,892.66
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$10,265.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,327.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,106.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,106.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,106.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,106.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC PERCUTANEOUS TUBE DRN CATH CHANGE
|
Facility
|
OP
|
$1,682.00
|
|
|
Service Code
|
CPT 75984
|
| Hospital Charge Code |
909001855
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.50 |
| Max. Negotiated Rate |
$1,513.80 |
| Rate for Payer: Adventist Health Commercial |
$336.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$504.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,429.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$925.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,261.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$406.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$565.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,059.66
|
| Rate for Payer: Blue Shield of California EPN |
$667.75
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,345.60
|
| Rate for Payer: Cigna of CA HMO |
$1,076.48
|
| Rate for Payer: Cigna of CA PPO |
$1,244.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,429.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,429.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,429.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,177.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.80
|
| Rate for Payer: EPIC Health Plan Senior |
$672.80
|
| Rate for Payer: Galaxy Health WC |
$1,429.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,009.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,513.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,068.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$992.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,177.40
|
| Rate for Payer: Multiplan Commercial |
$1,261.50
|
| Rate for Payer: Networks By Design Commercial |
$1,093.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,429.70
|
| Rate for Payer: Riverside University Health System MISP |
$672.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,009.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,009.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$841.00
|
| Rate for Payer: United Healthcare All Other HMO |
$841.00
|
| Rate for Payer: United Healthcare HMO Rider |
$841.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,429.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,429.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,429.70
|
|
|
HC PERCUTANEOUS TUBE DRN CATH CHANGE
|
Facility
|
IP
|
$1,682.00
|
|
|
Service Code
|
CPT 75984
|
| Hospital Charge Code |
909001855
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$336.40 |
| Max. Negotiated Rate |
$1,513.80 |
| Rate for Payer: Adventist Health Commercial |
$336.40
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,345.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,177.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.80
|
| Rate for Payer: EPIC Health Plan Senior |
$672.80
|
| Rate for Payer: Galaxy Health WC |
$1,429.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,009.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,513.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,068.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$992.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.40
|
| Rate for Payer: Multiplan Commercial |
$1,261.50
|
| Rate for Payer: Networks By Design Commercial |
$1,093.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,429.70
|
|
|
HC PERCUT RETRIEVAL F B
|
Facility
|
OP
|
$28,097.00
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
909020163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$436.09 |
| Max. Negotiated Rate |
$25,287.30 |
| Rate for Payer: Adventist Health Commercial |
$5,619.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,722.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Blue Shield of California Commercial |
$17,701.11
|
| Rate for Payer: Blue Shield of California EPN |
$11,154.51
|
| Rate for Payer: Cash Price |
$12,643.65
|
| Rate for Payer: Cash Price |
$12,643.65
|
| Rate for Payer: Cash Price |
$12,643.65
|
| Rate for Payer: Central Health Plan Commercial |
$22,477.60
|
| Rate for Payer: Cigna of CA HMO |
$17,982.08
|
| Rate for Payer: Cigna of CA PPO |
$20,791.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,667.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$23,882.45
|
| Rate for Payer: Global Benefits Group Commercial |
$16,858.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,287.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$436.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,841.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$481.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,619.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$21,072.75
|
| Rate for Payer: Networks By Design Commercial |
$18,263.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Prime Health Services Commercial |
$23,882.45
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,858.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,858.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,048.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14,048.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14,048.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,048.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC PERCUT RETRIEVAL F B
|
Facility
|
IP
|
$28,097.00
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
909020163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$5,619.40 |
| Max. Negotiated Rate |
$25,287.30 |
| Rate for Payer: Adventist Health Commercial |
$5,619.40
|
| Rate for Payer: Cash Price |
$12,643.65
|
| Rate for Payer: Central Health Plan Commercial |
$22,477.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,667.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,238.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,238.80
|
| Rate for Payer: Galaxy Health WC |
$23,882.45
|
| Rate for Payer: Global Benefits Group Commercial |
$16,858.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,287.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,841.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,577.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,619.40
|
| Rate for Payer: Multiplan Commercial |
$21,072.75
|
| Rate for Payer: Networks By Design Commercial |
$18,263.05
|
| Rate for Payer: Prime Health Services Commercial |
$23,882.45
|
|
|
HC PERCUT TREAT MALAR FX W/MANIPU
|
Facility
|
OP
|
$19,813.00
|
|
|
Service Code
|
CPT 21355
|
| Hospital Charge Code |
900501424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$244.76 |
| Max. Negotiated Rate |
$17,831.70 |
| Rate for Payer: Adventist Health Commercial |
$3,962.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,565.51
|
| Rate for Payer: Cash Price |
$8,915.85
|
| Rate for Payer: Cash Price |
$8,915.85
|
| Rate for Payer: Cash Price |
$8,915.85
|
| Rate for Payer: Cash Price |
$8,915.85
|
| Rate for Payer: Central Health Plan Commercial |
$15,850.40
|
| Rate for Payer: Cigna of CA HMO |
$12,680.32
|
| Rate for Payer: Cigna of CA PPO |
$14,661.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,869.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Galaxy Health WC |
$16,841.05
|
| Rate for Payer: Global Benefits Group Commercial |
$11,887.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,831.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,581.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$244.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,962.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$14,859.75
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$12,878.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,841.05
|
| Rate for Payer: Prime Health Services Medicare |
$4,520.08
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,690.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,887.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,906.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,906.50
|
| Rate for Payer: United Healthcare HMO Rider |
$9,906.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,906.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC PERCUT TREAT MALAR FX W/MANIPU
|
Facility
|
IP
|
$19,813.00
|
|
|
Service Code
|
CPT 21355
|
| Hospital Charge Code |
900501424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,962.60 |
| Max. Negotiated Rate |
$17,831.70 |
| Rate for Payer: Adventist Health Commercial |
$3,962.60
|
| Rate for Payer: Cash Price |
$8,915.85
|
| Rate for Payer: Central Health Plan Commercial |
$15,850.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,869.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,925.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,925.20
|
| Rate for Payer: Galaxy Health WC |
$16,841.05
|
| Rate for Payer: Global Benefits Group Commercial |
$11,887.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,831.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,581.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,689.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,962.60
|
| Rate for Payer: Multiplan Commercial |
$14,859.75
|
| Rate for Payer: Networks By Design Commercial |
$12,878.45
|
| Rate for Payer: Prime Health Services Commercial |
$16,841.05
|
|
|
HC PERICARDIOCENTESIS
|
Facility
|
OP
|
$743.00
|
|
|
Service Code
|
CPT 76930
|
| Hospital Charge Code |
909001449
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.60 |
| Max. Negotiated Rate |
$668.70 |
| Rate for Payer: Adventist Health Commercial |
$148.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$451.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$631.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$408.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$557.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$317.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$442.04
|
| Rate for Payer: Blue Shield of California Commercial |
$468.09
|
| Rate for Payer: Blue Shield of California EPN |
$294.97
|
| Rate for Payer: Cash Price |
$334.35
|
| Rate for Payer: Cash Price |
$334.35
|
| Rate for Payer: Central Health Plan Commercial |
$594.40
|
| Rate for Payer: Cigna of CA HMO |
$475.52
|
| Rate for Payer: Cigna of CA PPO |
$549.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$631.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$631.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$631.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$520.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$297.20
|
| Rate for Payer: EPIC Health Plan Senior |
$297.20
|
| Rate for Payer: Galaxy Health WC |
$631.55
|
| Rate for Payer: Global Benefits Group Commercial |
$445.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$668.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$471.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$269.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$438.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$520.10
|
| Rate for Payer: Multiplan Commercial |
$557.25
|
| Rate for Payer: Networks By Design Commercial |
$482.95
|
| Rate for Payer: Prime Health Services Commercial |
$631.55
|
| Rate for Payer: Riverside University Health System MISP |
$297.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$445.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$445.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$371.50
|
| Rate for Payer: United Healthcare All Other HMO |
$371.50
|
| Rate for Payer: United Healthcare HMO Rider |
$371.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$371.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$631.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$631.55
|
| Rate for Payer: Vantage Medical Group Senior |
$631.55
|
|
|
HC PERICARDIOCENTESIS
|
Facility
|
IP
|
$743.00
|
|
|
Service Code
|
CPT 76930
|
| Hospital Charge Code |
909001449
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.60 |
| Max. Negotiated Rate |
$668.70 |
| Rate for Payer: Adventist Health Commercial |
$148.60
|
| Rate for Payer: Cash Price |
$334.35
|
| Rate for Payer: Central Health Plan Commercial |
$594.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$520.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$297.20
|
| Rate for Payer: EPIC Health Plan Senior |
$297.20
|
| Rate for Payer: Galaxy Health WC |
$631.55
|
| Rate for Payer: Global Benefits Group Commercial |
$445.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$668.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$471.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$438.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.60
|
| Rate for Payer: Multiplan Commercial |
$557.25
|
| Rate for Payer: Networks By Design Commercial |
$482.95
|
| Rate for Payer: Prime Health Services Commercial |
$631.55
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
IP
|
$1,328.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
900501128
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$265.60 |
| Max. Negotiated Rate |
$1,195.20 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,062.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$929.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.20
|
| Rate for Payer: EPIC Health Plan Senior |
$531.20
|
| Rate for Payer: Galaxy Health WC |
$1,128.80
|
| Rate for Payer: Global Benefits Group Commercial |
$796.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,195.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$843.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$783.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: Networks By Design Commercial |
$863.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,128.80
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
IP
|
$1,328.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
900501128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$265.60 |
| Max. Negotiated Rate |
$1,195.20 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,062.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$929.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.20
|
| Rate for Payer: EPIC Health Plan Senior |
$531.20
|
| Rate for Payer: Galaxy Health WC |
$1,128.80
|
| Rate for Payer: Global Benefits Group Commercial |
$796.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,195.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$843.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$783.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: Networks By Design Commercial |
$863.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,128.80
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
OP
|
$1,328.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
909000125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$265.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$730.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$996.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$643.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$772.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,062.40
|
| Rate for Payer: Cigna of CA HMO |
$849.92
|
| Rate for Payer: Cigna of CA PPO |
$982.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,128.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,128.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$929.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.20
|
| Rate for Payer: EPIC Health Plan Senior |
$531.20
|
| Rate for Payer: Galaxy Health WC |
$1,128.80
|
| Rate for Payer: Global Benefits Group Commercial |
$796.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,195.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$843.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$482.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$783.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: Networks By Design Commercial |
$863.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,128.80
|
| Rate for Payer: Riverside University Health System MISP |
$531.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$796.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$664.00
|
| Rate for Payer: United Healthcare All Other HMO |
$664.00
|
| Rate for Payer: United Healthcare HMO Rider |
$664.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$664.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,128.80
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
OP
|
$1,328.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
900501128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$265.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$730.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$996.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$643.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$772.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,062.40
|
| Rate for Payer: Cigna of CA HMO |
$849.92
|
| Rate for Payer: Cigna of CA PPO |
$982.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,128.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,128.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$929.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.20
|
| Rate for Payer: EPIC Health Plan Senior |
$531.20
|
| Rate for Payer: Galaxy Health WC |
$1,128.80
|
| Rate for Payer: Global Benefits Group Commercial |
$796.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,195.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$843.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$482.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$783.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: Networks By Design Commercial |
$863.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,128.80
|
| Rate for Payer: Riverside University Health System MISP |
$531.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$796.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$664.00
|
| Rate for Payer: United Healthcare All Other HMO |
$664.00
|
| Rate for Payer: United Healthcare HMO Rider |
$664.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$664.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,128.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,128.80
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
IP
|
$1,328.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
909000125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$265.60 |
| Max. Negotiated Rate |
$1,195.20 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,062.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$929.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.20
|
| Rate for Payer: EPIC Health Plan Senior |
$531.20
|
| Rate for Payer: Galaxy Health WC |
$1,128.80
|
| Rate for Payer: Global Benefits Group Commercial |
$796.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,195.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$843.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$783.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.60
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: Networks By Design Commercial |
$863.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,128.80
|
|
